Sunday, July 22, 2012

Sundowning: Agitation in the Evening

I have to admit that I avoid visiting skilled nursing facilities (SNF) in the late afternoon and early evening. I have a handful of friends
who live in SNFs, and I have observed a phenomenon called
sundowning or sundowner’s syndrome, which affects a number of residents.

People with Alzheimer's disease and other dementias are prone to experience confusion and
agitation as the sun goes down, making it difficult to communicate with them
and care for them. For some
reason, people in the mid-stages of dementia seem to be most affected. Symptoms include the following: yelling,
crying, confusion, hallucinations, tremors, and pacing.

In an attempt to explain this phenomenon to younger women, I
have compared it to the struggle parents have when helping young children transitioning
from daycare or school into their evening activities and then to dinner and
then to their bedtime routine. These
transitions can happen in the space of just two hours, stressing the young
child. They suffer similar behavioral and emotional upset as older adults with
dementia. Older adults might need to transition from the
common rooms to the dining room, to their bedrooms and then into their pajamas
before retiring for bed—all within just two hours.

Experts speculate that those with dementia have fewer
reserves for managing the stress and fatigue that comes at the end of the day.
Some speculate that the body’s circadian rhythms are disrupted by dementia,
making it harder to transition from daytime activities to a full night’s sleep.

Even though I am not currently a caregiver, that might change. Family caregivers and professional caregivers have developed ways to address the agitation that often accompanies nightfall. Strategies to reduce sundowning include the following:

Limiting caffeine late in the day

Limiting sugar late in the day

Encouraging exercise

Limiting naps during the day

Keeping to a regular routine

Moving meal times earlier in the evening and
then providing a bedtime snack

Moving activities such as visitors, bathing,
doctor’s appointments, rehab visits, etc. away from late afternoon hours and
into morning or mid-day hours.